Policy on ED violence

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I'm curious to find out how your hospital handles violence against nurses. Recently (within the last several months) we have had a FF/known and documented drug seeker pull a knife and threaten the life of the RN and the unarmed security guard. Two days ago after confronting another known FF/drug seeker (professionally), this patient returned to the ER and threatened to bring a gun and kill the doctor and the nurses(me specifically) involved in the patient care. We have also had a known non-compliant schizophrenic become fixated o n one nurse and began stalking and threatening her. All of these were investigated by the police but to my knowledge no charges were filed because no actual crime was commited.

According to our current policy, we still HAVE to see and treat these patients, regardless of the personal and very real danger to ourselves. Our ED is not equipped with metal detectors, nor is it a locked unit. The doors are locked, but security is lax and all anyone must say is "My sister/brother/parent/friend is in room #9" and in they go. Our triage area has only one exit and it is behind the patient, not the nurse, leaving them essentially trapped.

I know that Emtala states that everyone is entitled to emergency care (to paraphase), but am I wrong in thinking that we should have a zero tolerance policy on accepting patients who have threatened to KILL us if they get the chance? I have been very verbal to my management that as the charge nurse I refuse to let these people through the doors and they will never get the opportunity to harm one of my nurses. The physician in question agrees with me. But upper management is sticking to the motto, "everyone reacts differently to being sick or in pain, some lash out and say things they don't mean."

So I ask, what are your policies, how is it handled? If I can piece together enough real information, maybe I can do a better job at protecting my staff. Thanks in advance for any replies.

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Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.

Ummm... I'm pretty sure it's a crime to threaten to kill someone...

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We were told that it s not enough to threaten, they must prove that the patient in question had intent to follow through OR the patient must actually commit a crime in order to be arrested and charged. So no, as far as we understand, it's not a crime until one of us is harmed. I'd like to be a little more pro-active than that. I'm sure others would as well

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Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.

Holy crap... that's ridiculous! Funny, I bet if that same guy walked in the police officers place of work and threatened to kill him or another officer it wouldn't be long before the matter was "taken care of"! Good luck to you... keep safe!

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Specializes in Emergency Dept, ICU.

The current ER I work at has a policy on violence as too: What ever happens to the nurse happens to the nurse, we're not getting involved or making policies because we don't won't to cause a scene in our community or file charges against patients we help. I did have one patient that punched a security officer in the nose and fought me as well. And he went to jail when discharged. But it wasn't the hospital that filed charges or gave a dam* it was me picking up the phone and dialing 911 afterwards and saying I want to file charges. The local police here in Nashville will be glad to file charges if you call em.

Every other ER I have worked at, the security officers have always HAD weapons and the authority to arrest. We also always had psych/lockdown rooms and were not afraid to use them for our violent patients...psych or not.

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Specializes in Emergency.

I can't say much for policies...but, you need to beef up the security to protect staff and other patients. Discuss the use of panic buttons in all rooms, having a locked unit, and implementing a 2-visitor/patient rule (visitors must check in at triage and must wear a pass before they are allowed to go through locked doors to the main ED area; obviously this rule can be modified, especially if there's a PNB or critical patient). Discuss the importance of documenting exactly what the patient says (ie "I'm going to come back and kill you all"). On patients who are a threat to themselves or others, we have security 1:1 with them and all belongings are removed and they are searched with a metal detector.

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

Basically,

Each time they come to the ED we are obligated to provide the MSE (Medical Screening Exam), if no emergency exists, they can be discharged with no further treatment/interevntion.

We'll do this every time they come in - this is federal law (COBRA/EMTALA)

However, should they decide to being to act out, verbally threaten, make overt gestures, become disruptive etc. AND not respond to re-direction, in that they continue to de-stabilize the care area; then we will have them removed.

We have several who have "restraining orders" against them (due to prior behaviors) and all that means is that once they have received their MSE (if they will cooperatievly allow it) then they are to be off the premesis.

To the poster who feels his/her facility does not support them with policies or the ability/support to prosecute; I would say you need to do a couple of things

1) Talk to your board of nursing, specifically make the topic about staff safety

2) Get involved with your local/state Emergency Nurses Association

3) Confidentially talk to your state's labor dept/board

...basically, labor laws REQUIRE your employer to provide a SAFE workplace, free from violence or the threat of violence.

Let me tell you, in my 15+ years, whenever I have heard someone state that their admin doesn't support them - once they have done some of the above steps -OR- gone and spoken with their Director/CNO - things HAVE changed....sometimes it's a mis-perception and it needs clarification.

Bottom line; you employer is legally required to provide a safe workplace. If you really feel it's unsafe and people are in jeopardy, just go get you a first "free" consultation with an attorney who specializes in labor law; they would DROOL at the opportunity to get a hospital to settle a case like that; especially if ANY damages had ever occurred from the facility's failure to act.

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We were told that it s not enough to threaten, they must prove that the patient in question had intent to follow through OR the patient must actually commit a crime in order to be arrested and charged. So no, as far as we understand, it's not a crime until one of us is harmed. I'd like to be a little more pro-active than that. I'm sure others would as well

Assault is a crime, and does not require physical contact. The physical contact is called battery. As I understand it if you have reason to believe the threatener can and might carry out the threat. Somebody's status as a patient does not change that.

http://legal-dictionary.thefreedictionary.com/Assault

Obligations under EMTALA are widely misuderstood= mboswell summed them up well.

we have had a FF/known and documented drug seeker pull a knife and threaten the life of the RN and the unarmed security guard.

If you actually have somebody in a supervisory position that thinks that what you have described does not constitute a crime, that person is a moron.

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Specializes in Trauma, Teaching.

In NM, we have a law that says lower levels of assault (verbal) against a health care worker while performing their duties, are misdemeanors. Assault with threats to kill become a felony, battery is anywhere from a 4th degree felony on up, depending on severity.

Our ER security do not have guns, but do have the whip out type batons. Haven't ever seen them use them. They do respond pretty quickly and take down violent patients.

Local PD shows up really fast when we call, they're great about it.

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Specializes in Trauma, Teaching.

To the OP, you don't have to have the hospital's permission to call the police when you are being threatened with a knife!

Just call!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Our local PD know us well, and can and will arrive VERY quickly if there is an issue. Our security guards aren't exactly armed, and there are only a couple of them that could actually take a patient down if a situation went south.

Not long ago, we had a patient threaten our charge nurse and our doc when he didn't get narcs -- he said if he saw them on the street, he would eff them up. Our charge nurse called the PD and reported it, and they tracked the guy down and scared the crap out of him. Heh. I doubt that pt. could really hurt a fly (he's fairly aged and frail), but there's a point where you can't let things slide.

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